Why is Medicare backdating my father's income to September?

1 answer | Last updated: Jun 18, 2010
A fellow caregiver asked...

My father is on Medicare part B. He had his feet amputated over the summer and is currently staying at a nursing home. Through a recommendation from the social worker I applied for Medicaid for him. During the interview they told me that they were back dating the coverage to September, which means that my dad now has to pay all of his income to Medicaid (over $4,000) that he received since September of this year. Would you please tell me why they want to go back this far? Why can't the coverage start now? My plan is to bring him home in a couple of weeks- can't he just stay on the coverage he has?

Expert Answers

There are two different Medicaid rules that seem to be at work in your father's situation. One is that Medicaid eligibility can actually be retroactive up to three months. The other rule, not applicable in every state but apparently so where your father lives, is that someone can be eligible for Medicaid even if their income would normally be too high to qualify, if they have large medical bills.But that rule -- called the "spend down" rule -- requires the eligible person to pay as much of the medical bills as his income will cover before Medicaid will pay the rest.So, for any period that your father is eligible for Medicaid, he will have to use his income (minus amounts allowed for his living expenses) to pay his medical bills, and when his income is used up, Medicaid will pay the rest.If this somehow works to your father's disadvantage for any period of time, you and your father can ask to be taken off the Medicaid rolls for that period.That means that for that period he would go back in the situation he was in before applying for Medicaid.